Substance use disorders harm not only the user but also their romantic partner, who may develop negative codependent traits. This narrative review examines how psilocybin-assisted therapy can treat substance use disorders and how MDMA, already used for PTSD, might also address codependency in a spouse affected by their partner's addiction. Combining both substances with couples therapy could reduce addictive behaviors in one partner while shifting codependent behaviors in the other. The review discusses clinical implications, limitations of current research, and suggests further study of psychedelic-assisted couples therapy.
People seeking psychedelic-assisted therapy (PAT) currently access it through diverse and unregulated avenues, including ketamine clinics, psilocybin centers, clinical trials, and underground therapy. A survey of 244 self-identified PAT patients identified three distinct patterns of lifetime drug use: a High-PAT class (55.7% of the sample) who used many psychedelics, a Medium-PAT class (29.1%), and a Psilocybin-Ketamine class (15.2%) whose members universally used psilocybin and often ketamine. The High-PAT class reported higher levels of depression and anxiety, suggesting that extensive PAT involvement may be linked to more severe psychiatric symptoms, though whether this reflects selection or iatrogenic effects remains unclear. Psilocybin and ketamine may serve as common entry points into PAT.